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  • Navigating “Meaningful Use Rapids” – Physician Onboarding

    April 14, 2015 Karen Wilding / Director of Operations / University Of Maryland Medical System

    Anantachai (Tony) Panjamapirom / Senior Consultant / The Advisory Board Company

    DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

  • “EHR4ALL," The Legacy of Robin Raiford

    Health IT Enthusiast and Advocate Robin "sang the gospel" of the meaningful use program. She was a tireless advocate of its aims. One of her crowning achievements was the White Board Story, which "told the story" of all the meaningful use-related regulations in one huge "poster."

    To say Robin commanded a room when she spoke about health IT, is an understatement. Her dedication for this industry and its hope for transformative change exuded from her every cell. We carry on Robin's vision for that future where everyone uses the systems she believed would change the way we provide healthcare, and for the better.

    Robin Stillings Raiford February 4, 1952 - June 26, 2014

  • Conflict of Interest Karen Marie Wilding Salary: University Of Maryland Medical System, Community College of Baltimore County Other: Board of Directors, Maryland HIMSS, Chair of Program Planning Anantachai (Tony) Panjamapirom Salary: The Advisory Board Company

    © HIMSS 2015

  • Learning Objectives 1. Identify at least three components to assess when onboarding a provider into

    an existing organization's meaningful use program.

    2. Recognize two elements of risk in the meaningful use program that can arise in the EHR incentive program that are beyond the scope of the regulation in the circumstance of a provider changing practices, or in the situation of an acquired practice.

    3. State the year and stage of meaningful use that a provider would be in if he/she was acquired by an practice that was currently in Stage 2, Year 1 of meaningful use - but previously in the same reporting period that provider was demonstrating Stage 1, Year 1 objectives and measures.

  • An Introduction to the Benefits Realized for the Value of Health IT

    S Savings

    P Prevention and Patient Education

    E Electronic

    Information/Data

    T Treatment/

    Clinical

    S Satisfaction

    • Increase provider satisfaction by reducing administrative burdens

    • Assist operational teams with actionable guidance

    • Develop tools and checklists to ensure operational consistency

    • Generate a high level of data integrity, useful for performance evaluation

    • Ensure all providers, especially in an acquisition or new hire situation, achieve meaningful use, which provides better quality of care

    • Maintain program status by meeting and exceeding the critical patient objectives of VDT, patient education, clinical reminders etc.

    • Reduces risk of payment adjustments

    • Provides consistency in processes, reducing operational inefficiencies

    • Identifies Total Cost of Ownership, more accurately

    Source: University of Maryland Medical System; The Advisory Board research and analysis.

  • Roadmap

    Tracking EP meaningful use statistics and trending provider mobility and practice changes Identifying potential unintended consequences/risks of provider mobility

    Operationalizing successful practices in physician onboarding preparation for meaningful use success

  • 86%

    14%

    EP Registration, Attestation, and Payment Break Down as of February 2015

    Registration Attestation Incentive Payments

    32%

    46%

    22%

    64% 32%

    4%

    Medicaid Medicare

    Source: February 2015: EHR Incentive Program” Centers for Medicare and Medicaid, available at http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/February2015_SummaryReport.pdf (accessed April 8, 2015); Data Analytics Update: Health IT Policy Committee Meeting, The Office of National Coordinator for Health Information Technology, available at http://www.healthit.gov/FACAS/sites/faca/files/HITPC_Data_Analytics_Update_2015-04-07_FINAL.pdf, The Advisory Board research and analysis.

    Estimated Actual

    369,000 393,000

    145,000 176,000

    AIU

    MU Registered

    only

    Medicaid

    Medicare

    MU

    Registered only

    Medicare

    Medicaid

    Medicare Advantage

    Total: $11,117,356,994

  • Growing Larger, Hospital-Owned Practices

    Declining Reimbursements

    Increasing Operating Costs

    Sequestration cuts

    Potential Shortage of Physicians

    Regulations such as the ACA

    Business Complexity

    Market Consolidation

    69%

    39% 26%

    58%

    2005 2006 2007 2008 2009 2010

    Physician Owned Hospital Owned

    Medical Group Ownership

    41%

    33%

    12% 10%

    13% 18%

    3% 4% 1996-1997 1998-1999 2000-2001 2004-2005

    1-2 3-5 6-50 >50

    Changes in Physician Practice Size

    Source: MGMA, “2012 MGMA Physician Compensation and Production Survey Report,” available at: mgma.com; Center for Studying Health System Change, http://facts.kff.org/chart.aspx?ch=185 and http://www.hschange.com/CONTENT/941/?topic=topic22; The Advisory Board research and analysis.

    http://facts.kff.org/chart.aspx?ch=185 http://www.hschange.com/CONTENT/941/?topic=topic22

  • UMMS Experiencing High Influx B

    us in

    es s

    D riv

    er s

    R eg

    ul at

    or y

    D riv

    er s

    Acquisition New Service Line

    Affordable Care Act Maryland

    HSCRC

    Population Health Management

    9 12

    Change in Number of Hospitals

    Change in Number of Employed Physicians

    125

    450+

    2010 2014

    2010 2014

    Source: University of Maryland Medical System; The Advisory Board research and analysis.

  • Roadmap

    Tracking EP meaningful use statistics and trending provider mobility and practice changes

    Identifying potential unintended consequences/risks of provider mobility

    Operationalizing successful practices in physician onboarding preparation for meaningful use success

  • Key Areas to Watch with Moving EPs

    2 Financial

    Issues

    1 3 Legal Issues

    Operational Issues

    Source: The Advisory Board research and analysis.

  • Potential Industry Payment Adjustments in 2015

    Average Incentives Received as of February 2015

    Financial Issues

    Incentive Payments Payment Adjustments

    $1,110 Internal Medicine (Income2: $185K)

    $1,668 $2,430 Oncology

    (Income2: $278K) Orthopedics

    (Income2: $405K)

    Per Medicaid Eligible Professional

    Per Medicare Eligible Professional

    Per Medicare Advantage Eligible Professional

    $25,833

    $25,348 $29,831

    Assume 60% Medicare Reimbursements

    Source: February 2015:: EHR Incentive Program” Centers for Medicare and Medicaid, available at http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/February2015_SummaryReport.pdf (accessed April 8, 2015); The Advisory Board research and analysis.

    Questions to Consider for both Incoming and Departing Providers

    1. Who should receive an incentive payment?  EP, the previous

    employer, or the current employer?

     Majority of time rule? 2. Who is responsible for

    payment adjustment of the EP’s past performance?  EP, the previous

    employer, or the current employer?

     Shared responsibility?

  • Legal Issues

    Legal and Compliance Must Be Engaged to Ensure Onboarding and Departing Agreements

    Contract Development

    • Screening questionnaires embedded into hiring process

    • Consider incorporating provisions to address financial and operational risks incurred by an EP’s inability to meet MU

    Partnership with Finance Collaboration with the Meaningful Use Team

    • Identify potential financial risks of a non meaningful user status

    • Understand the risks in the total acquisition cost and consider negotiation

    • Keep an ongoing pulse check of an individual provider status

    • Provide advisory support for an unprecedented issue

    Source: The Advisory Board research and analysis.

  • Operational Issues

    Incoming Eligible Provider

    Departing Eligible Provider

    Successful coordination with the previous and next employer is key!

    Identify Provider Meaningful Use

    Status

    Retrieve Performance Data

    and Reporting

    Request Audit Documentation

    Source: The Advisory Board research and analysis.

  • Roadmap

    Tracking EP meaningful use statistics and trending provider mobility and practice changes

    Operationalizing successful practices in physician onboarding preparation for meaningful use success

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